Episode Treatment Groups

On March 10th, OptumInsight decided to make an important contribution to advancing the national performance measurement conversation, as any interested stakeholder can now access, understand, and potentially improve our leading methodology for grouping episodes of care.

Identifying clinical episodes of illness and the services involved in their diagnosis, management and treatment has become a key business need of any health care organization. Episodes of care provide a valuable unit of analysis to measure health care and provide incentives for high performance. We seek to improve the understanding, utility and quality of Episode Treatment Groups which will lead to better and more consistent calculations of key health care quality and cost metrics. While ETGs have been widely used to understand and compare episodes of care across patients, providers, and populations; they also need to evolve to reflect the increasingly complex nature of care. This point marks an ambitious advance in that evolution. We invite you to be a part of this dialogue and help contribute to the performance measurement discussion.

About ETGs

ETGs were introduced in the mid-1990s as a condition classification methodology that combines related services into a medically relevant and distinct unit describing a complete episode of care. The clinical richness of episodes of care and their reliance on information readily available from medical and pharmaceutical insurance claims make them a sound unit of analysis to support transparency, measure health care quality and cost, and provide incentives for higher quality care. Today, ETG-based products are licensed by more than 300 U.S. health care organizations, serving more than 75 percent of the insured population.

OptumInsight offers access to ETG core content and methodologies for all 542 currently supported disease conditions. With that insight, interested parties can make informed suggestions and recommendations on how to improve the clinical constructs of the ETGs. Reviewers will have the opportunity to post their recommendations on the “Recommendation” tab.